Provider Demographics
NPI:1902318173
Name:CROSS, VICTORIA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535-1983
Mailing Address - Country:US
Mailing Address - Phone:617-936-9001
Mailing Address - Fax:
Practice Address - Street 1:62 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535-1983
Practice Address - Country:US
Practice Address - Phone:617-936-9001
Practice Address - Fax:617-936-9001
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health